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LG290 <br /> (9/11190) <br /> minnesota Lawful Gambling <br /> Application for Registration of Bingo Manager of <br /> Nursing Home, Senior Citizen Housing Project <br /> or Senior Citizen Organization Conducting Bingo <br /> Name of Organization Phone Number <br /> �'h og u r 2i e. g u J3)9A &4RJFN-%5 (651 <br /> Address city State Zip Code <br /> -7-6-41P t'-, Fill 2, V; nd;E-6�1� 1 — �J JF- <br /> 44; hh�g 444 qF-.&s /441 0 <br /> Indicate type of organization <br /> ❑ Nursing Home Senior citizen housing project ❑ Senior citizen oroanization <br /> Our . . .. <br /> lge .. ... <br /> I affirm that <br /> • Bingo will be conducted within a nursing home or senior citizen housing project or by a senior citizen <br /> organization. <br /> • Prizes for a single bingo game will not exceed $10. <br /> • Total prizes awarded at a single bingo occasion will not exceed $200. <br /> • No more than two bingo occasions will be held by the organization or at the facility each week. <br /> • Only members of the organizaWn or residents of the nursing home or housing project will be allowed to <br /> play in a bingo game. <br /> • No compensation will be paid for any persons who conduct the bingo. <br /> • The manager will supervise the bingo. <br /> • The manager is registered with the Gambling Control Board. <br /> • Gross receipts from bingo conducted under the limitations outlined above are exempt from taxation under <br /> chapter 297A. <br /> Signature of manager Title Date <br /> 'A <br /> Name or �maaaer please prirrt� Phone number <br /> 0 4LP4 ' cifi eqRAS <br /> Acknawledgeuzeut of Registration <br /> ........... . . ..... <br /> nature of Exacutiv 'rector, Control Division Date <br /> Mail to: 13 79! <br /> Department of Gaming <br /> Gambling Control Division <br /> Rosewood Plaza South, 3rd Floor <br /> 1711 W. County Road B <br /> Roseville, MN 55113 <br /> A copy of the signed registration will be returned to the organization <br />